OHSU Presentation Template - White

TeleHealth OverviewEMS Stroke ConferenceJune 2014

1No disclosures (darn).2ObjectivesDescribe applications of telemedicineLearn about future applications of telemedicineLearn how about performance metricsSee a demo of telemedicineUnderstand challenges of telemedicine3What Is Telemedicine?Using telecommunication technology (aka video-conferencing equipment)

Improves Access to CareQuality of CareProvider & Patient Satisfaction

Reduces Cost

Interactive Healthcare over Distance4So what is telemedicine - strictly defined its ..Here is a photo of me providing Dr. Tom Roe of Eugene a consult (there I am on the v-c equipment) on this critically ill stuffed animal - whose name and condition I cant disclose due to HIPAA - Privacy concerns - I hope youll understand - this was for a media piece that ran in the Eugene Register and on the local TV stations.Historically when physicians need to a consult theyve picked up a telephone and call. They then describe to the best of their ability what theyre seeing. Telemedicine adds live streaming video so that both are seeing the same thing.Triage Decisions

Consult calls received 24/7

The Dilemma for ER Providers & OHSU ProvidersWhether to Transport based on a verbal report plus institutional, provider, & parental comfort levels

Who is impacted by the Decision?PatientFamilyTransport TeamFinancial Impacts to Healthcare System, Family, & Local EconomyPANDA to Eugene (by ground ambulance): $6,322 PANDA to Medford (fixed wing plane): $21,572 Now Id like to briefly explain the role that we play as Pediatric Intensivists in the care of these kids. We receive phone calls throughout the day & night from community hospital ERs seeking advice on management of these critically ill children. Now its important to recognize that many of the smaller hospitals throughout the state only see a small handful of really sick kids a year and when they so show up it can create a great deal of anxiety, which you can often hear in their voices on the other end of these calls. The dilemma we face is to make a decision with the referring provider of whether or not to transport the child to Portland. Were counting on the ability of the remote team to both properly assess the child and to then communicate that assessment verbally over the phone. And while we know from the data, that many of these kid could be safely cared for in their community, if there is any question on either side of the call, we often default to transporting the child either by ground ambulance, fixed wing planes from greater distances, or in emergent conditions, by helicopter. Unfortunately at times, the child is unnecessarily transported at great expense to many.

The impact of this decision is widespread. Obviously & most importantly, the childs care could be dramatically affected. Transporting the child also places a significant hardship on Parents who are removed from their community, its support, their other children, their jobs, etc.An in the winter, when the wind is blowing or the roads are icy, both the patient and our PANDA transport team is put at risk.

Additionally, the financial impacts are great with hits to the healthcare system, the payors, the family, and the local economy from the loss of healthcare dollars and other associated spending. An example is the cost of just the medical transport which is in excess of $6000 by ground from Eugene for example to a shocking $21,000 for a plane ride from Klamath Falls.

SO is there a way to help with this dilemma, that could provide not only an improvement in the quality of care, but also reduce potentially dangerous and often times unnecessary transports with cost savings to all?

5Telemedicine Becoming Mainstream

6TeleHealth Across the Continuum of CareContinuum of CarePrehospital careWhere is it?7Acute Care Telemedicine

Program began 2007PICU to Sacred Heart, EugeneMotivationsImprove care pre-transportBetter TriageAvoidance of unnecessary, expensive, & risky transports

Expansion Service linesStroke, PICU, NICU, Trauma, NeurosxGenetics, Psychiatry

Expansion 16 sitesbased on local needs8Emergency/Nursery Consults by MonthSince May 2010: 734 emergent consults 418 Transfers to OHSU (57%) 315 remained in home community (43%)9Telemedicine Consults by Service LineTotal Consults (May 2010-June 2014): 734Averted transport savings: > $4,700,000

As of 8/9/12-340 consults

consults stayed in local community (30% of total)

10OHSU: TeleStroke ProgramLocal OHSU Stroke Neurologist activates the robot- if transferred they are involved in the patients care.

24/7/365 Neuro- interventionalist coverage- > 300 cases of stroke thrombectomy experience.

23 year track record of Tele-phone stroke coverage which we are making even better with video.

TeleStroke Experience

12Quality Review TeleStroke Results

501 telestroke consults since May 2010

24% of patients received tPA vs. national average 2-3%

Drip & Ship vs. Drip and Keep

54% of pts stayed in the community

13OHSU Connection

14TeleStroke Consult to Mercy MC, RoseburgTelestroke Demo

15Rogue Regional Tele-Stroke Stats109 Total Tele-Stroke Consults

75% of those patients stayed in their home community

Estimated Transport Savings: $1,929,500

Demo Time! 16

Telestroke: Use in Stroke Tx1. Patient examined 10:15 via telestroke; TPA given2. INR TX explained and consent obtained from his wife 10:45.3. Case and ETA reviewed with Lifeflight- left 10:554. Arrived OHSU 11:40; exam repeatedStentriever 11:50 (335 post onset)Stroke onset 8:15; OSH 70 miles from OHSU

Ambulatory TeleHealth

Delivering Value to Patients and PayersAccess to appropriate follow-up care improves compliance & outcomesCost containmentMultiple applicationsPost-op checksChronic disease mgmtLess mobile populations OHSU Pt homeincluding prisons

18TeleStroke: Use in Clinical Care

Yearly F/U visit La Grande 225 miles from OHSU

Ambulatory Outreach

20Ambulatory OutreachNew Tools

3M Littman Stethoscope

Total ExamCamHD

21SNF/LTACH Discharges TeleHealthReadmissions can be reduced by more effective discharge transitions 167 readmissions from SNF/LTACH (30 day all cause) in FY 2013Linked to strategically important continuum sitesVibra - Prestige AvamereWarm Video-enabled nurse-to-nurse HandoffsEducational Brown BagsTelemedicine consults

22In Home Monitoring Congestive Heart Failure79 patients enrolled since December, 201280% of patients completed the program Some patients dropped out, couldnt connect, etc Average number patients monitored per day ranges from 2 to 6 ,with a high of 9Average Telephone Encounters per patient is 7 calls per month versus 11 - 14 encounters prior to program Average call length is shorter in duration and more focusedReported ED visits in the interim of 30 days with 65 patientsSelf efficacy scores improvingExpanding to diabetes via Internal Medicine primary care practice

23Telemedicine and EMS:Started in the 70s with ECG telemetryOn-site decision supportRoutine and disaster triageExchange of informationVoice, data, imagesInformation (12-lead reports, treatment protocols)Transport decision support (acuity based)Language interpretationTransport support

24Special Rolling Stroke Response UnitGermany

Includes:Mobile 8-slice CT scanner w/ ability for angiography and perfusionPOC laboratoryData transmitted over encrypted 3G, 4G and satelliteRural application for Oregon?25Mobile CTIn an Ambulance

26Clinical Service Pilots & in DevelopmentOregon Perinatal & Neonatal Network (OPNN)CCO Cardiology demonstration with HealthShare

ED Virtual Bunker as Triage CenterTele-Psychiatry ExpansionTele-Retinopathy of Prematurity ExamsPediatric Hospice

Tele-Genetics ExpansionTele-TraumaTele-EEG, Echo, Ultrasound

27Telemedicine ChallengesStarting a Program Takes Time & MoneyInfrastructure (staff, equipment, connectivity, time)Adoption (administrative, providers, patients) Roadblocks - Legislative, Rules, Tech, etc.Credentials & LicensesEquipment re Stark ImplicationsConnectivityReimbursementSenate Bill 24 passed by 09 Oregon LegislatureMedicare billing limitations (urban vs. rural)

28Resources OHSU Telemedicineohsu.edu/telemedicineTelehealth Alliance of Oregonortelehealth.orgNorthwest Regional Telehealth Resource Center, Spokane, WAnrtrc.orgAmerican Telemedicine Associationamericantelemed.orgCenter for Telehealth & E-Health Lawctel.orgOffice for the Advancement of Telehealthtelehealth.hrsa.gov

29Thank You

OHSU TeleHealth Services503-418-362530